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APA Wants Comprehensive ADHD Treatment

The American Psychiatric Association (APA) says children with attention deficit hyperactivity disorder should be diagnosed by parents and doctors, and not by school officials.

In testimony before the U.S. House Committee on Education and the Workforce, David Fassler, M.D., said diagnosis of ADHD requires a comprehensive assessment by a trained clinician -- something can't be done in a five- or ten-minute office visit.

"Other problems such as anxiety disorders, depression and learning disabilities present some of the same symptoms as ADHD and more than half of children with ADHD have another psychiatric problem," said Fassler, who testified for the APA and for the American Academy of Child and Adolescent Psychiatry.

"In addition to direct observation, the evaluation includes a comprehensive review of the child's development, social, academic and medical history," he explained. "It should also include input from the child's parents and teachers, and a review of the child's records. Schools play a critical role in identifying kids who are having problems, but schools should not make diagnoses or dictate treatment.

"I share the concern that some children may be placed on medication without a comprehensive evaluation, an accurate and specific diagnosis, or an individualized treatment plan," said the child and adolescent psychiatrist who chairs the APA Council on Children, Adolescents and Their Families.

Fassler emphasized that the diagnostic criteria for ADHD contained in the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM) are specific, well-established within the field, and based on extensive academic and clinical research.

The current DSM states that the essential feature of ADHD "is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at comparable level of development."

It adds, "there must be clear evidence of interference with developmentally appropriate social, academic, or occupational functioning."

If the diagnosis is accurate, "medication, including methylphenidate or Ritalin, can be extremely helpful for many children, but medication alone is rarely the appropriate treatment for complex child psychiatric disorders such as ADHD," Fassler added.

The APA is also concerned "about the many children with ADHD and other psychiatric disorders who would benefit from treatment, including treatment with medication, who go unrecognized and undiagnosed, and who are not receiving the help that they need.

"Child psychiatric disorders, including ADHD, are diagnosable and real illnesses, and they affect lots of kids. The good news is that they are also highly treatable. We can't cure all the kids we see, but with comprehensive, individualized intervention, we can significantly reduce the extent to which their problems interfere with their lives. The key for parents and teachers is to identify kids with problems as early as possible, and make sure they get the help that they need," he concluded.

Reprinted with permission courtesy of School Health Professional. Published in the October 18, 2000 issue. For subscription information, call 1-800-421-2795.

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